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Abstract：
Racial disparities in opioid prescribing are widely documented, though few studies assess racial differences in the postoperative setting specifically. We hypothesized standard opioid prescribing schedules reduce total opioids prescribed postoperatively and mitigate racial variation in postoperative opioid prescribing.
This is a retrospective review of adult general surgery cases at a large, public academic institution. Standard opioid prescribing schedules were implemented across general surgery services for common procedures in late 2018 at various timepoints. Interrupted time series analysis was used to compare mean biweekly discharge morphine milligram equivalents prescribed in the preintervention (Jan-Jun 2018) versus postintervention (Jan-Jun 2019) periods for Black and White patients. Linear regression was used to compare mean difference in discharge morphine milligram equivalents among White and Black patients in each study period, while controlling for demographics, chronic opioid use, and procedure/service.
A total of 2,961 cases were analyzed: 1,441 preintervention and 1,520 postintervention. Procedural frequencies, proportion of Black patients (17% Black), and chronic opioid exposure (7% chronic users) were similar across time periods. Interrupted time series analysis showed significantly lower mean level of morphine milligram equivalents prescribed postintervention compared with the predicted nonintervention trend for both Black and White patients. Adjusted analysis showed on average in 2018 Black patients received significantly higher morphine milligram equivalents than White patients (+19 morphine milligram equivalents, 95% confidence interval 0.5-36.5). There was no significant difference in 2019 (-8 morphine milligram equivalents, 95% confidence interval -20.5 to 4.6).
Standard opioid prescribing schedules were associated with the elimination of racial differences in postoperative opioid prescribing after common general surgery procedures, while also reducing total opioids prescribed. We hypothesize standard opioid prescribing schedules may mitigate the effect of implicit bias in prescribing.
This is a retrospective review of adult general surgery cases at a large, public academic institution. Standard opioid prescribing schedules were implemented across general surgery services for common procedures in late 2018 at various timepoints. Interrupted time series analysis was used to compare mean biweekly discharge morphine milligram equivalents prescribed in the preintervention (Jan-Jun 2018) versus postintervention (Jan-Jun 2019) periods for Black and White patients. Linear regression was used to compare mean difference in discharge morphine milligram equivalents among White and Black patients in each study period, while controlling for demographics, chronic opioid use, and procedure/service.
A total of 2,961 cases were analyzed: 1,441 preintervention and 1,520 postintervention. Procedural frequencies, proportion of Black patients (17% Black), and chronic opioid exposure (7% chronic users) were similar across time periods. Interrupted time series analysis showed significantly lower mean level of morphine milligram equivalents prescribed postintervention compared with the predicted nonintervention trend for both Black and White patients. Adjusted analysis showed on average in 2018 Black patients received significantly higher morphine milligram equivalents than White patients (+19 morphine milligram equivalents, 95% confidence interval 0.5-36.5). There was no significant difference in 2019 (-8 morphine milligram equivalents, 95% confidence interval -20.5 to 4.6).
Standard opioid prescribing schedules were associated with the elimination of racial differences in postoperative opioid prescribing after common general surgery procedures, while also reducing total opioids prescribed. We hypothesize standard opioid prescribing schedules may mitigate the effect of implicit bias in prescribing.
摘要：
阿片类药物处方中的种族差异被广泛记录，尽管很少有研究专门评估术后设置的种族差异。我们假设标准阿片类药物处方时间表减少了术后处方的总阿片类药物，并减轻了术后阿片类药物处方的种族差异。
这是对成人普外科病例的回顾性回顾，公共学术机构。标准阿片类药物处方时间表在2018年底的不同时间点在普通手术服务中实施。中断时间序列分析用于比较黑白患者干预前（2018年1月至6月）与干预后（2019年1月至6月）规定的平均每两周一次的吗啡毫克当量。线性回归用于比较每个研究期间白人和黑人患者的放电吗啡毫克当量的平均差异。在控制人口统计的同时，长期使用阿片类药物，和程序/服务。
总共分析了2,961例：干预前1,441例和干预后1,520例。程序频率,黑人患者比例（17%黑人），慢性阿片类药物暴露(7%的慢性使用者)在不同时间段相似。中断的时间序列分析显示，与黑人和白人患者的预测非干预趋势相比，干预后处方的吗啡毫克当量平均水平显着降低。调整后的分析显示，2018年黑人患者平均接受的吗啡毫克当量明显高于白人患者(+19吗啡毫克当量，95%置信区间0.5-36.5)。2019年无显著差异(-8吗啡毫克当量，95%置信区间-20.5至4.6)。
标准阿片类药物处方时间表与消除普通普外科手术后阿片类药物处方的种族差异有关，同时还减少了处方的阿片类药物总量。我们假设标准的阿片类药物处方时间表可以减轻处方中隐性偏见的影响。
这是对成人普外科病例的回顾性回顾，公共学术机构。标准阿片类药物处方时间表在2018年底的不同时间点在普通手术服务中实施。中断时间序列分析用于比较黑白患者干预前（2018年1月至6月）与干预后（2019年1月至6月）规定的平均每两周一次的吗啡毫克当量。线性回归用于比较每个研究期间白人和黑人患者的放电吗啡毫克当量的平均差异。在控制人口统计的同时，长期使用阿片类药物，和程序/服务。
总共分析了2,961例：干预前1,441例和干预后1,520例。程序频率,黑人患者比例（17%黑人），慢性阿片类药物暴露(7%的慢性使用者)在不同时间段相似。中断的时间序列分析显示，与黑人和白人患者的预测非干预趋势相比，干预后处方的吗啡毫克当量平均水平显着降低。调整后的分析显示，2018年黑人患者平均接受的吗啡毫克当量明显高于白人患者(+19吗啡毫克当量，95%置信区间0.5-36.5)。2019年无显著差异(-8吗啡毫克当量，95%置信区间-20.5至4.6)。
标准阿片类药物处方时间表与消除普通普外科手术后阿片类药物处方的种族差异有关，同时还减少了处方的阿片类药物总量。我们假设标准的阿片类药物处方时间表可以减轻处方中隐性偏见的影响。
